Provider Demographics
NPI:1710035720
Name:GOODERMAN, STEWART F (OD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:F
Last Name:GOODERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:490 POST ST
Mailing Address - Street 2:STE 1606
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-1313
Mailing Address - Country:US
Mailing Address - Phone:415-576-1121
Mailing Address - Fax:415-576-1001
Practice Address - Street 1:490 POST ST
Practice Address - Street 2:STE 1606
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1313
Practice Address - Country:US
Practice Address - Phone:415-576-1121
Practice Address - Fax:415-576-1001
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA06673T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist